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, <br /> ; <br /> ��y� <br /> O xl � Y � <br /> � Hfn � <br /> H�� � � <br /> o '�� INGIDN � p� g ; <br /> �x� �� Buildi�q Record ��# , <br /> o� d �� : <br /> ��g ;�� � CLASSIFICATION -�" I <br /> ,., y i <br /> y (pleasr check onel (please check one) � <br /> rC ai� ❑New Bullding ❑AddfNon over 500 sq.8. 0 Single Family ❑Duplex � <br /> o rJ[�n Jurisdictiorr __ �;.___—_—-- ❑Multilamilq ❑Zero Lot Line Home <br /> ��� - _ ❑Planned Um, _�evelopment � <br /> y oiease check one: ❑ City ❑County Permil# . <br /> H O tn File ID#(il diNerenrlrom Permir A�_ . . �� <br /> � :. , � <br /> � � CONSTRUCTION " ��:�'�' �:�� ? ;��� <br /> _ <br /> A. Site Intonnation 8. Owner Information ___ _ _ �, <br /> Address __ Owner �m�,�erarnmeotronsrnxxanreceiwsuniMaarmm� <br /> �'_ — �.. r, e t Z�P .— T Company —— - — - — <br /> Asseesor'sProp�1'ax# orairacniega�descdprmn)___ Address _ ______ _ i�� <br /> -- C�ty — - , .. State� Zip ,. i <br /> 9.—— �= — -- Phone ' <br /> Servicin Electric Utilit ' _ _ -�— � <br /> FederallD#orSSN ____ <br /> /_.. � <br /> ( C�'; C. If Single Family,2ero Lot Line or D. If Multifamily(R-1)_ __ <br /> � � Planned Unit Development — Total k of Buildings -- _ <br /> Total Conditioned Floor Area sq.It. Tolal#ot Units <br /> � �� Second Duplex Unit_ sq.fL Total sq.iL(ophonal) __ <br /> I ,`�� Nf AT SOURCE � ___ <br /> �� A. Prfmary Speca 4eat Type B. Back.-Up Space Heat Type C. Water Heat Type <br /> I ''� (check onel._ _ . __ . (cptlonnl.check all(hal aPP�Y7 (opllonal, oheck onel---_-- - <br /> ❑ Electric Base6oard ❑ IVone ❑ Electric <br /> ❑ ElectricFurn�„e ❑ 1Vood ❑ Gas <br /> ` <br /> ❑ Electric Heat Pump ❑ Electric Baseboard ❑ Other ispecny neio��� <br /> �'� Glhe�lspecity oclmv) <br /> ❑ Other (_y,ecry�berow) - — — <br /> i.', , <br /> ���� COMPLIANCE INSPECTIOtUENFORCEMENT ' <br /> ! WSEC Compliance Method Date o(Permit Application ___ <br /> ❑ Prescriptive Path Date Buildin�Permit Issued _. --,�_ <br /> ���' Date of Insulation Ins ection __ <br /> ❑ ComponentPerformance —P— <br /> ❑ System Analysis Date of Final Inspeclion ___ _ _ ____ __ <br /> 1 horeby certfly fhat thls bullding or addifion has been lnspecfed/or the measures reouJred <br /> b}•the 1991 Washington Sfafe Energy Code(WSEC), that if is in subsfantfal complfance <br /> �vilh fhe WSEC,and lhat fhe WSEC checklisf lor this building is on lile. <br /> 9gnatwe ol f3uiltling 011icial or Aulhorized Representativa Dale <br /> ReWrn white copy to: Kathleen Skaar, Washinglon Sale Energy Oflice. 809 Legion Way SE,FA-11. Olympia,WA 98504-1211 <br /> WSEO-IM1'hrta CoPY Ul�liry Owncr-Canary CoPY Junsdtfion�Pink CoPY 6-91 <br />